Developing an endoscopic mucosal resection service in a district general hospital

OBJECTIVE: To describe the implementation of a formal single-operator led endoscopic mucosal resection (EMR) service in a district general hospital, and the effect on patient outcome of this service development. DESIGN: Prospective audit during initiation and subsequent development of EMR service. SETTING: District general hospital. PATIENTS: All patients referred to EMR service between 1 January 2008 and 31 December 2011. INTERVENTIONS: Nil in addition to clinical care. MAIN OUTCOMES MEASURED: The number of EMRs per year including polyp size and histology, recurrence of polyp tissue at 3 months following EMR, and complications including early/delayed bleeding and perforation. RESULTS: Following service implementation, the number of EMRs rose from 11 in 2008 to 35 in 2011, with the number of large polyps (>30 mm) rising from four in 2008 to 24 in 2011. Recurrent or residual adenomatous tissue fell from 75% in 2008 to 4.76% in 2011. Only one perforation occurred over the 4 years (0.8% perforation rate: 1 in 120 polypectomies). A reduction in surgical intervention for adenomatous polyp removal was observed during the audit period. CONCLUSIONS: Professional engagement and support by medical, surgical and nursing members of the endoscopy team promoted development of skill and confidence in EMR. Exposure to higher volumes of EMR procedures allowed successful removal of larger lesions, while maintained patient safety and reduced the need for surgical removal of benign polyps.